Everybody's Doing It - Health Care Leaders Appeal to Common Practice

There were two examples in the recent news about how health care leaders employ logical fallacies to advance their positions.<br /><br /><strong>Caritas Christi / Cerberus</strong><br /><br />We <a href="http://hcrenewal.blogspot.com/2010/04/more-doubts-about-private-equity-taking.html">posted</a> recently about the proposed takeover of the not-for-profit Caritas Christi hospital system by the Cerberus Capital Management private equity firm. We proposed skepticism about the idea. For-profit hospitals have not been shown to provide better, cheaper, or more accessible care than not-for-profit hospitals. There is reason to worry that a private-equity firm would put margin ahead of mission. The Boston Herald <a href="http://www.bostonherald.com/jobfind/news/healthcare/view/20100402caritas_ceo_health_reform_to_bankrupt_us/srvc=home&position=also">interviewed</a> Dr Ralph de la Toree, the current CEO of Caritas Christi, who would continue to run the health system after the takeover. Asked about the role of Cerberus,<br /><blockquote>De la Torre dismissed concerns that Cerberus’ executives - and their investments - may not jibe with Caritas’ social justice mission.<br /><br />Cerberus investor J. Ezra Merkin, for example, is facing civil fraud charges because of his ties to disgraced money manager Bernard Madoff. Besides its failed Chrysler investment, Cerberus has also invested in companies, such as gunmaker Remington Arms, that some Catholics may not support.<br /><br />De la Torre admitted Cerberus has a diverse portfolio and said<em> most boards of local nonprofits have members who have made their money through questionable means</em>.</blockquote><br />The last sentence is a good example of the <a href="http://www.nizkor.org/features/fallacies/appeal-to-common-practice.html">appeal to common practice</a>. Basically, the logical fallacy is that because many do it, doing it must be good. <br /><br />Although we are often critical of the cronyism of boards of for-profit corporations and not-for profit organizations, even I would not go so far as to suggest that most boards include people who have made money unethically. Regardless of the prevalence of this pheonomenon, however, boards of health care organizations should be composed of people of integrity and honesty who support the mission of the organizations. <br /><br /><strong>Professor Uwe Reinhardt</strong><br /><br />We recently <a href="http://hcrenewal.blogspot.com/2010/04/mainstream-media-discovers-conflicts-of.html">posted</a> about how prominent health economist and public health care intellectual Professor Uwe Reinhardt of Princeton University has failed to disclose conflicts of interest when opining about health policy. A follow-up <a href="http://www.sfgate.com/cgi-bin/article.cgi?f=/g/a/2010/04/06/businessinsider-new-york-times-health-care-blogger-defends-lack-of-disclosure-on-his-5-million-in-health-related-stock-2010-4.DTL">interview</a> of Reinhardt on SFGate.com included:<br /><blockquote>I invite you to look at the Wall Street Journal [reporters] and <em>see their list of boards</em>. </blockquote><br />I have no idea whether Wall Street Journal reporters fail to disclose their memberships on boards of companies relevant to the subject of their reporting. We have frequently discussed <a href="http://hcrenewal.blogspot.com/search/label/conflicts%20of%20interest">conflicts of interest</a> and how they can influence medical care, teaching and research, and health care research and policy. I agree that  such conflicts are frequent, and often go undisclosed. Again, however, Prof Reinhardt seemed to be using an appeal to common practice. Just because others have failed to disclose conflicts of interest does not make such failure right. <br /><br />Interested readers may want to review the interviews of De La Torre and Reinhardt to see if they can find other logical fallacies.<br /><br />Note that we have frequently quoted Dr Joe Collier, "people who have conflicts of interest often find giving clear advice (or opinions) particularly difficult."  [Collier J. The price of independence. Br Med J 2006; 332: 1447-9. Link <a href="http://bmj.bmjjournals.com/cgi/content/full/332/7555/1447">here</a>.] We have discussed examples of how conflicted people seem to easily resort to <a href="http://hcrenewal.blogspot.com/search/label/logical%20fallacies">logical fallacies</a> to defend their conflicts (e.g., see post <a href="http://hcrenewal.blogspot.com/2009/07/again-logical-fallacies-in-defense-of.html">here</a>.) <br /><br />I do not think it is too much to ask prominent health care leaders to use evidence and logic, not logical fallacies to make their arguments.<br /><br />Those who do use logical fallacies are inviting even more skepticism about their arguments and the agenda behind them.

Everybody's Doing It - Health Care Leaders Appeal to Common Practice

There were two examples in the recent news about how health care leaders employ logical fallacies to advance their positions.Caritas Christi / CerberusWe posted recently about the proposed takeover of…

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Who Guards the Guardians? - the Case of Boston Scientific

The fallout from the case of the faulty implantable cardiac defibrillators continues.  To summarize the story thus far,<br /><br />We started posting about Boston Scientific's travails in 2005, starting with allegations that Guidant, which is now a Boston Scientific subsidiary, hid information about defects in the implantable cardiac defibrillators (ICDs) the company manufactured. As we noted in early 2005 <a href="http://hcrenewal.blogspot.com/2005/05/guideants-short-circuit.html">here</a>, Guidant executives allegedly knew that ICDs made from 2000-2002 were at risk for short-circuiting and failing, thus making them unable to deliver potentially life saving electrical shocks meant to prevent cardiac arrests, but the company only revealed the problem in 2005. By failing to notify physicians and the public, Guidant executives let expensive and profitable, but potentially useless devices to continue to be implanted, potentially increasing the risk of sudden death for the patients who received them. Then here we <a href="http://hcrenewal.blogspot.com/2005/06/guidants-short-circuit-reloaded.html">noted</a> reports that Guidant continued to ship failure-prone devices even after it had designed and started to manufacture new ICDs that were supposed to be less likely to fail. By June, 2005 we <a href="http://hcrenewal.blogspot.com/2005/06/more-short-circuits-for-guidant.html">posted</a> that Guidant had recalled thousands of ICDs, including models that were previously not identified as likely to fail. Later that year, the case <a href="http://hcrenewal.blogspot.com/2005/07/new-england-journal-of-medicine-on.html">rated</a> an article by Robert Steinbrook in the New England Journal of Medicine. Towards the end of 2005, we <a href="http://hcrenewal.blogspot.com/2005/11/eliot-spitzer-sues-guidant-for-fraud.html">noted</a> that Eliot Spitzer had sued Guidant for fraud.  At the end of the year, more information <a href="http://hcrenewal.blogspot.com/2005/12/for-guidant-these-people-are-just.html">appeared</a>, suggesting that Guidant knew the ICDs were flawed, but continued to sell them. <a href="http://hcrenewal.blogspot.com/2006/03/more-about-guidant-it-is-possible-that.html">Still more</a> appeared early in 2006. Then the business media became interested in the bidding war between Johnson and Johnson and Boston Scientific for Guidant, provoking a bit <a href="http://hcrenewal.blogspot.com/2006/01/new-problems-for-guidant-and-boston.html">more interest</a> in the tale of the suppression of data about the flawed ICDs.<br /><br />Then all was quiet until 2009, when Guidant, now a Boston Scientific subsidiary, <em>pleaded guilty to two criminal misdemeanor charges</em> that it failed to properly notify the FDA about problems with its ICDs (see post <a href="http://hcrenewal.blogspot.com/2009/11/boston-scientific-to-plead-guilty-of.html">here</a>). Later, the Guidant subsidiary of Boston Scientific settled charges that it gave doctors kickbacks as part of a "seeding study" to use its devices. At that time, it came to light that Boston Scientific had made another settlement, in 2007, of civil lawsuits alleging that the company hid problems with its products (see post <a href="http://hcrenewal.blogspot.com/2009/12/boston-scientific-again-settles-this.html">here</a>).<br /><br />More details about this guilty plea have just been reported.  As <a href="http://www.startribune.com/business/89963612.html">noted</a> by the Minneapolis Star-Tribune, <br /><blockquote>A federal judge on Monday delayed a decision on whether to accept a $296 million plea agreement between the U.S. Justice Department and Boston Scientific Corp.'s Guidant subsidiary, which was charged with concealing critical safety information involving some of its top-selling heart devices.<br /><br />If approved,<em> the criminal penalty would rank as the largest ever in medical technology</em> for a company that violated the federal Food, Drug and Cosmetic Act. But lawyers representing victims implanted with the potentially faulty devices threw a wrench into what was expected to be a routine hearing by <em>demanding a piece of the settlement</em>.</blockquote><br />It appears that this settlement would not do any specific good for patients who claim to have been harmed by being implanted with a device that the manufacturer knew at the time to be faulty.<br /><br />Also, the Star-Tribune noted:<br /><blockquote>Boston Scientific bought Guidant Corp., whose cardiac rhythm division is based in Arden Hills, for $27 billion in 2006. Though troubled, the division that makes pacemakers and defibrillators reported $2.6 billion in sales last year and still employs 2,000 people locally.</blockquote><br />Thus, the financial penalty to be paid by Boston Scientific only would amount to little over ten percent of the yearly sales generated by the division which failed to disclose the faulty devices.<br /><br />Adding to the sense that Boston Scientific and its leadership will feel little pain from the "largest criminal penalty ever assessed against a medical device company" (see <a href="http://www.google.com/hostednews/ap/article/ALeqM5i6EeKMw1uQyqOJxROb_E5H2vMIeQD9ET7VCO0">this AP report</a>) was <a href="http://www.boston.com/business/articles/2010/04/06/success_or_no_ceos_score/">this op-ed </a>in the Boston Globe. It summarized just how richly the former CEO of Boston Scientific, Jim Tobin, who presided over the acquisition of Guidant and thus became responsible for its ethical lapses, and the current CEO, Ray Elliott have been compensated, in contrast to this supposedly large penalty. Re Tobin:<br /><blockquote>Tobin came to Boston Scientific in 1999 with similar instructions to clean up somebody else’s mess. He had to close facilities, ward off competitors, and, yes, settle patent lawsuits even back then. His carrot: A million stock options, a big deal in those days.<br /><br />Tobin did fix some problems, and he brought the company’s new drug-eluting stent to market. Boston Scientific shares climbed, and<em> he made about $39 million on options over the years</em>. But <em>Tobin also collected problems, the ones now in Elliott’s lap, and Boston Scientific shares fell again</em>.<br /><br />So here’s what the board did in February last year: It awarded Tobin 2 million more stock options, just a few months before announcing his retirement.<br /><br />Adjusting for a stock split, <em>the second option grant is the same size as what he got upon arrival</em>.</blockquote><br />And re Elliott:<br /><blockquote>Elliott, the man named as CEO of Boston Scientific Corp. last summer, became <em>one of the best-paid chief executives in America in 2009</em>. Separate national surveys published in the past week by The Wall Street Journal and The New York Times, although incomplete, come up with just one or two large-company CEOs with compensation packages that could outdo Elliott’s <em>$33.5 million payday</em>.</blockquote><br />And see also <a href="http://hcrenewal.blogspot.com/2010/03/new-investigations-of-boston-scientific.html">this Health Care Renewal post</a>.  <br /><br />TheBoston Globe editorialist asked "so what exactly was the point of the second award [to Tobin]?"  Perhaps this question should be directed to the <a href="http://www.bostonscientific.com/AboutUs/Leadership.bsci/,,/navRelId/1004.1012/seo.serve">Boston Scientific board</a> who approved it, and also approved Elliott's outsize pay package.  <br /><br />The current board includes two co-founders of the company and the current CEO, two retired politicians, a few others with whom I am not familiar, but also two academics who may be quite familiar to Health Care Renewal readers.  <br /><br />Recalling that Boston Scientific tried to plead guilty to charges of "making false statements ... to the FDA," and "failing to promptly notify regulators," it is striking that both these academics have had issues with transparency and free speech.  We just <a href="http://hcrenewal.blogspot.com/2010/04/mainstream-media-discovers-conflicts-of.html">posted</a> about the repeated failure of Prof Uwe Reinhardt to acknowledge the conflict of interests generated by his numerous memberships in the boards of health care companies, including Boston Scientific, when writing about health policy issues.  We have previously <a href="http://hcrenewal.blogspot.com/2006/03/new-species-of-conflict-of-interest-in.html">posted</a> about the the conflicts of Marye Anne Fox, the Chancellor of the University of California - San Diego and hence leader of its medical school and academic medical center.  Chancellor Fox has just been <a href="http://www.thefire.org/article/11612.html">criticized</a> by FIRE (the Foundation for Individual Rights in Education) for allowing the silencing of a student publication and television station which had published or broadcast opinions that apparently offended university leaders.<br /><br />So who in this sorry tale will stand up for quality care of patients?  The US Department of Justice is to be commended for pursuing deception by a large medical device company, but apparently could not bring itself to request a punishment for unethical practices likely to even inconvenience those responsible for the bad behavior.  The previous and current company CEOs have become quite rich without having to stand up for honesty, or patient safety.  The board of directors who are supposed to take responsibility for the overall direction of the company seem to have been happy just to go along.<br /><br />As I have <a href="http://hcrenewal.blogspot.com/search/label/legal%20settlements">said</a> before, endlessly, we will not deter unethical behavior by health care organizations until the people who authorize, direct or implement bad behavior fear some meaningfully negative consequences.  Relatively small fines imposed on large corporations pain workers on the line and stockholders while sparing the richly paid top hired management and the boards that will not reign them in.  <br /><br />Real health care reform needs to make health care leaders accountable, and especially accountable for the bad behavior that helped make them rich. 

Who Guards the Guardians? - the Case of Boston Scientific

The fallout from the case of the faulty implantable cardiac defibrillators continues.  To summarize the story thus far,We started posting about Boston Scientific's travails in 2005, starting with alle…

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Mainstream Media "Discovers" Conflicts of Interest of Prominent Health Policy Pundit

The main-stream media, in this case <a href="http://www.sfgate.com/cgi-bin/article.cgi?f=/g/a/2010/04/06/businessinsider-new-york-times-health-care-blogger-secretly-holds-5-million-in-health-care-stocks-2010-4.DTL">the San Francisco Chronicle</a>, just "discovered" an important case of a conflicted health policy pundit, <br /><blockquote>Uwe Reinhardt, a Princeton economic professor who often writes about health care for the New York Times' Economix blog, <em>earns more than $500,000 a year working for a number of health care companies. He also holds more than $5 million worth of related stock</em>.<br /><br />Reinhardt's <a href="http://www.nytimes.com/ref/business/economy/reinhardt.ready.html">NYT bio</a> <em>does not mention these financial relationships</em>.<br /><br />As the <a href="http://www.nytpick.com/2010/04/ethics-breach-princeton-prof-who-writes.html">NYTPicker points out</a>, Reinhardt's various incomes <em>break the New York Times rules</em>, which ban anyone who writes for the paper from having any financial interest 'in a company, enterprise or industry that figures or is likely to figure in coverage that he or she provides, edits, packages or supervises regularly.'<br /><br />We asked the New York Times for comment. They sent us this email:<br /><br />'Professor Reinhardt is a leading expert on the economics of health care, and has provided valuable and independent insights in his blog posts. He has mentioned his service on corporate boards in the blog, but we are reviewing how to more fully describe his activities for readers of Economix.'<br /><br />We also asked Reinhardt for comment. He is working on one for us and we will post it here as soon as possible.<br /><br />Here's the breakdown of what he owns, according to NYTPicker:<br /><br />* Reinhardt either earns an income or stock options from the five different private health care companies for which he sits on the board of directors/serves as a trustee.<br />* He has sat on the board of health care company, Amerigroup, since 2003. This tenure has resulted in Reinhardt's accumulation of 144,558 shares in the company and $226,531 in cash-and-stock compensation. These shares are currently valued around $4.8 million.<br />* Reinhardt also holds 75,625 shares of Boston Scientific (worth more than $500,000 in value) and earned $213,132 from the company in 2009. He has sat on the board of this medical device manufacturing company since 2005.<br />* Reinhardt serves as a trustee for H&Q Healthcare Investors and H&Q Life Science Investors. His 2008 income from the companies included $43,000 in income and between $1 and $10,000 worth of securities.<br />* He also made $2.3 million from the 2007, $5.1 billion sale of Triad Hospitals to Community Health Systems.</blockquote>It only took four years for this to get into the main-stream media. The reason "discovered" is in quotes is that we have been writing about Reinhardt's conflicts of interests vis a vis his prominent opinions on health policy since 2006 on <a href="http://hcrenewal.blogspot.com/">Health Care Renewal</a>. <br /><br />As I wrote in a comment on the original NYTPicker post, in 2006, we first <a href="http://hcrenewal.blogspot.com/2006/03/economist-puts-down-physicians-cri-du.html">wrote</a> about a letter to the editor of the NY Times by Reinhardt dismissing a physician op-ed writer's concerns about what has gone wrong with health care.  Reinhardt's letter failed to disclose the board memberships he held at that time. In 2009, we <a href="http://hcrenewal.blogspot.com/2009/01/what-ruc-prominent-health-care-policy.html">wrote</a> about how Reinhardt left out some crucial facts in his discussion in the Economix blog of how physicians are paid. That year we also <a href="http://hcrenewal.blogspot.com/2009/05/what-influenced-paean-to-karen-ignagne.html">wrote</a> about how Reinhardt defended Ms Karen Ignagni, CEO of America's Health Insurance Plans (AHIP) in an interview quoted in a Washington Post article.<br /><br />In neither case above did Reinhardt or the newspaper reveal his conflicts.<br /><br />Note that Reinhardt is not the only case of a prominent health policy expert with undisclosed conflicts of interest. See <a href="http://hcrenewal.blogspot.com/2006/03/new-species-of-conflict-of-interest-in.html">this post </a>for some examples we had found in 2006.<br /><br />In fact, in my humble opinion, the public discourse about health care policy in general, and health care reform in particular has been seriously distorted by various commentators, pundits, and experts who have major conflicts of interest, usually in the form of important financial relationships with large health care organizations.  In many cases, these conflicts are not disclosed.  A related problem is the influence of various non-profit organizations that are heavily funded by those with vested interests, usually in selling particular health care products or services.  Such funding is also rarely disclosed.  <br /><br />I further submit that this distortion has overwhelmingly been in favor of various aspects of the status quo that have been so profitable for the discussants, and their commercial sponsors.  This distortion has meant that certain important problems, especially those that we discuss on Health Care Renewal, are rarely even mentioned in the mainstream media, in journals on health care and services research and health policy, and in political discussion.  Try, for example, to find any discussion of the impact of ill-informed, self-interested, conflicted or corrupt leadership of prominent health care organizations on costs, access and quality, or on patient outcomes.  It is simply not done to discuss the shortcomings of leadership, maybe because it is this leadership who subsidizes many of the pundits, commentators and experts.  <br /><br />At a minimum, participants in the health policy discussion, starting with the most prominent, should fully disclose all financial relationships that could constitute conflicts of interest.  <br /><br />Meanwhile, those listening to the discussion should be extremely skeptical about the opinions expressed. 

Mainstream Media "Discovers" Conflicts of Interest of Prominent Health Policy Pundit

The main-stream media, in this case the San Francisco Chronicle, just "discovered" an important case of a conflicted health policy pundit, Uwe Reinhardt, a Princeton economic professor who often write…

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Boston Scientific (Again) Settles - This Time, Charges of Kickbacks Disguised as Clinical Studies

One would think that the stories about bad behavior by health care organizations would quiet down just before Christmas, but no...<br /><br />As reported <a href="http://www.google.com/hostednews/ap/article/ALeqM5i6EeKMw1uQyqOJxROb_E5H2vMIeQD9CP8M1O0">by the AP</a>:<br /><blockquote>U.S. attorneys in Boston said Wednesday heart device maker <em>Boston Scientific will pay $22 million to resolve allegations its Guidant division paid kickbacks to doctors to get them to use its heart devices.</em><br /><br />The U.S. Department of Justice said Guidant paid physicians $1,000 to $1,500 each in 2003 and 2004 to participate in four studies, called RaCE, RaCE II, RaCE III, and MERITS. It said the studies were designed to increase sales of pacemakers and defibrillators.<br /><br />Federal officials said the <em>company targeted doctors who favored products made by other companies, hoping the payments would induce them to use Guidant devices more often</em>. They said Guidant submitted claims for payment on the devices to Medicare.<br /><br />Boston Scientific did not admit wrongdoing as part of the civil settlement. Under the agreement, its cardiac rhythm management division will have to publicly disclose payments to physicians on a Web site. Boston Scientific also entered into a <em>corporate integrity agreement</em>.<br /></blockquote><br />So here we have an example of a "<a href="http://hcrenewal.blogspot.com/2008/08/article-in-annals-of-internal-medicine.html">seeding study</a>," that is, a marketing effort to persuade physicians to prescribe a product disguised as a clinical research study, but for medical devices, not drugs.  Seeding studies seem to combine multiple kinds of unethical behavior, deceptive marketing and manipulated research.  There had been some question in the past whether seeding studies exist, but this is the second recent example to come to light, suggesting that not only do they exist, but that they are used by device as well as pharmaceutical companies.<br /><br />Note that, as <a href="http://www.bloomberg.com/apps/news?pid=20601103&sid=a0ZPcYxXqf88">Bloomberg reports</a>, this is the third major settlement of allegations of bad behavior made by Boston Scientific, <br /><blockquote>The company agreed last month to pay $296 million to settle a Justice Department probe into Guidant’s handling of heart devices and restated third-quarter results. [See post <a href="http://hcrenewal.blogspot.com/2009/11/boston-scientific-to-plead-guilty-of.html">here</a>.] In 2007, Boston Scientific agreed to pay $240 million to settle more than 8,000 lawsuits claiming Guidant hid defects in defibrillators, which are devices that shock the heart back into regular rhythm. <br /></blockquote>Cataloging legal settlements seems to be a useful way to assess the sorts of bad behavior manifested by large health care organizations (see some posts <a href="http://hcrenewal.blogspot.com/search/label/legal%20settlements">here</a>). However, as we have said frequently, such settlements, including the "corporate integrity agreements" now frequently attached to them, seem to have done little to deter bad behavior.  Usually, the companies involved only need to pay fines, and no individual who performed, directed or approved unethical or illegal acts will suffer any negative consequences. I submit once again that such fines are viewed merely as costs of doing business by the affected companies, and do not deter future bad behavior.<br /><br />I submit that would-be health care reformers who want to improve care, reduce costs and improve access should advocate for real negative consequences for people who implement, direct or approve the various versions of fraud, kickbacks, and miscellaneous corruption and malfeasance we have discussed on Health Care Renewal.<br /><br />By the way, the <a href="http://www.bostonscientific.com/AboutUs/Leadership.bsci/,,/navRelId/1004.1012/seo.serve">board of directors</a> of Boston Scientific includes two noted academics with leadership roles in academic health care.  Marye Anne Fox is the <a href="http://www-chancellor.ucsd.edu/leadership.html">Chancellor of the University of California - San Diego</a>, and hence the leader of a major medical school and academic medical center.  The <a href="http://www.ucsd.edu/explore/about/index.html">university's mission statement</a>, alongside which sits her picture, proclaims it "strives to maintain a climate of fairness, cooperation, and professionalism." Uwe Reinhardt, Professor at Princeton, is a noted health care economist, and <a href="http://economix.blogs.nytimes.com/author/uwe-e-reinhardt/">blogger on the Economix blog</a> for the New York Times.  Perhaps such august academic personages could tell  us how they are assuring that the company they are paid well to oversee upholds, rather than undermines professionalism and fairness.

Boston Scientific (Again) Settles - This Time, Charges of Kickbacks Disguised as Clinical Studies

One would think that the stories about bad behavior by health care organizations would quiet down just before Christmas, but no...As reported by the AP:U.S. attorneys in Boston said Wednesday heart de…

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What Influenced a Paean to Karen Ignagne?

As the discussion here in the US about health care reform gathers steam, the Washington Post published a rather uncritical <a href="http://www.washingtonpost.com/wp-dyn/content/article/2009/05/24/AR2009052400551.html">profile</a> of one of the prominent participants, Ms Karen Ignagni, CEO of America's Health Insurance Plans (AHIP), the trade group for the health insurance/ managed care industry. It included some compliments from Princeton Professor and prominent health care economist Uwe Reinhardt:<br /><blockquote><br /><em>'Whatever AHIP pays her, it's not enough. She's unbelievably effective,'</em> said Princeton economist Uwe Reinhardt. 'It's just amazing what she's achieved for them against all odds.'<br /><br /><em>Ignagni's total compensation, according to AHIP's most recent filing from 2007, was $1.58 million</em>, which includes $700,000 in base salary, $370,000 in deferred compensation and a bonus. Ignagni won't say how many hours a week she works. The number's so high it's embarrassing, she said.<br /><br />Among successes cited by Reinhardt and others is helping persuade the Bush administration to develop private insurance plans within Medicare that are producing unexpectedly high payments for private insurers.<br /></blockquote><br />What the Washington Post article did not bother to mention was that in addition to being on the Princeton faculty, Professor Reinhardt is a member of the <a href="http://phx.corporate-ir.net/phoenix.zhtml?c=122199&p=irol-govboard">board of directors </a>of <a href="http://www.amerigroupcorp.com/Pages/Home.aspx">Amerigroup</a>, a health insurance company specializing in providing Medicaid and Medicare managed care (see this <a href="http://hcrenewal.blogspot.com/2009/01/what-ruc-prominent-health-care-policy.html">previous post</a>), and a member of AHIP. Former Amerigroup CEO Jeffrey McWalters was <a href="http://orlando.bizjournals.com/gen/executive.html?excode=406F5DF537D14F3AACA5084EC5142068">on the board of AHIP</a>. According to Amerigroup's<a href="http://ccbn.10kwizard.com/xml/download.php?repo=tenk&ipage=6228231&format=PDF"> 2009 proxy statement</a>, Professor Reinhardt controls (via ownership or options) 144,558 shares of Amerigroup stock, and received $226,531 in compensation from Amerigroup in 2008.<br /><br />Perhaps Professor Reinhardt's enthusiasm for Karen Ignagne's performance as CEO of AHIP derived more from his leadership of Amerigroup than a scholarly analysis.<br /><br />Note also that Professor Reinhardt is a member of the <a href="http://phx.corporate-ir.net/phoenix.zhtml?c=62272&p=irol-govBoard">board of directors </a>of <a href="http://www.bostonscientific.com/">Boston Scientific</a>, a medical device company. Furthermore, per proxy statements from the above companies, Professor Reinhardt is on the board of two funds from H&Q Healthcare Investors, and is a Trustee of Duke University and the Duke University Health System.<br /><br />Professor Reinhardt's leadership roles in US publicly traded corporations are public, but not easily found unless one knows where to look. We had first <a href="http://hcrenewal.blogspot.com/2006/03/economist-puts-down-physicians-cri-du.html">discussed</a> these relationships on Health Care Renewal in 2006. However, many of the more academically tinged biographies of him publicly available omit his leadership roles in the for-profit world. At the moment, biographies of Professor Reinhardt on the <a href="http://wws.princeton.edu/people/display_person.xml?netid=reinhard&all=yes">Princeton web-site</a>, and furnished by the <a href="http://www.princeton.edu/~bioethic/about_us/advisors/reinhardt.html">Princeton Bioethics Forum</a>, the <a href="http://www.commonwealthfund.org/bios/bios_show.htm?doc_id=239402">Commonwealth Fund</a>, and the <a href="http://www.kff.org/about/reinhardt.cfm">Henry J Kaiser Foundation </a>did not note these relationships.<br /><br />This illustrates once more participation in the current health policy debate may be driven by vested interests, rather than ideology, much less dispassionate analysis. Were the participants yo disclose, at least, their financial interests, the debate would become that much clearer. Meanwhile, when listening to the debate, always ask, "cui bono?" (Who benefits?)<br /><br />Hat tip to <a href="http://www.thehealthcareblog.com/the_health_care_blog/2009/05/im-not-sure-thats-how-uwe-meant-it.html">the Health Care Blog</a>.

What Influenced a Paean to Karen Ignagne?

As the discussion here in the US about health care reform gathers steam, the Washington Post published a rather uncritical profile of one of the prominent participants, Ms Karen Ignagni, CEO of Americ…

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BLOGSCAN - Whose Interests Does Health Care Advocacy Serve?

<span style="color:#006600;">Merrill Goozner, </span><a href="http://www.gooznews.com/archives/001390.html"><span style="color:#006600;">on the GoozNews Blog</span></a><span style="color:#006600;">, dissected recent pronouncements on health care reform by economist Uwe Reinhardt. Reinhardt compared our US "system" of financing health care with those of some other countries. He noted some advantages of the latter systems, but wondered whether US citizens would accept the trade-offs they implied. In particular, he wondered whether the US would accept the tight regulation of private insurance companies found in Germany. But he conveniently failed to note that the German plan's success may depend on its exclusive use of only not-for-profit health insurers. Mr Goozner wondered whether if this omission had to do with Mr Reinhardt's position on the board of a for-profit US health insurance company, a relationship not disclosed in Mr Reinhardt's New York Times blog post. (We have </span><a href="http://hcrenewal.blogspot.com/2009/01/what-ruc-prominent-health-care-policy.html"><span style="color:#006600;">posted</span></a><span style="color:#006600;"> before about how Mr Reinhardt's authoritative writings on health policy have not been accompanied by disclosure of his positions on the boards of several major health care corporations.) Once again, it is hard to tell whose interests prominent health care advocacy serves.</span>

BLOGSCAN - Whose Interests Does Health Care Advocacy Serve?

Merrill Goozner, on the GoozNews Blog, dissected recent pronouncements on health care reform by economist Uwe Reinhardt. Reinhardt compared our US "system" of financing health care with those of some…

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